When someone dies on the streets of Baltimore, as 344 people did last year, the emotional costs are well documented. These are important stories—and get to the heart of the emotional devastation that such violence wreaks on families. (See here and here to read about the enduring psychological impact of this ordeal.) But there are additional aspects of this crime that are often overlooked: What exactly happens to the victim of the gunshot and what is the true financial cost of murder?
Few of us know what happens to the body of the victim as it moves through the system or what costs accrue as a result of Baltimore's skyrocketing murder rate. City Paper decided to investigate the process and to estimate the attendant costs based on the best available data.
There is a tendency toward euphemism and away from directness when writing about the dead. Typically people think they are protecting surviving family members from further anguish by avoiding an uncomfortable subject; often family members, like the sister of a murder victim this reporter spoke to who now works in a local funeral parlor, actually want to know details surrounding a death. To straddle these two perspectives, this article does not follow a named victim but a hypothetical John Doe.
John Doe, based on statistically likely homicide victims this year, is a 25-year-old African-American male who was shot in the chest on the corner of North Avenue and Druid Hill Avenue at 2:26 a.m. He is rushed to the emergency room at University of Maryland Medical Center's Shock Trauma, Johns Hopkins Hospital, or Sinai. In addition to the 344 people who were murdered in the city last year (90 percent of them shot), 556 others were shot and survived, requiring costly medical attention not even included here. According to the Centers for Disease Control, which calculates its totals based on average percentages of insured, uninsured and Medicaid recipients in Maryland, hospital emergency rooms cost the public $14,000 per firearm death.
Not all of Baltimore's homicides were gun related but most were (and the cost differences for treating, say, a stabbing victim, were not significant). Rough total: $4.8 million for medical costs to treat Baltimore's homicides this year.
What happens to a body?
If John Doe is shot, say on the corner of a street, and is already clearly dead when police arrive, the crime scene is sealed off and police investigators work their way from the periphery of the scene toward the center, where the body lies. Technically, the crime scene falls under the jurisdiction of the police, but the cadaver belongs to the medical examiner. When police have done their work, they call the medical examiner’s office and a forensic investigator is dispatched.
"We go to every scene every time," says Bruce Goldfarb, public information officer for the Office of the Chief Medical Examiner, explaining that the dead are brought to Maryland's state-of-the-art forensic medical center on West Baltimore Street. The six-story building contains 22 autopsy stations, digital radiology equipment, an advanced "biosafety level III" facility for processing infectious remains, teaching facilities, and on the ground floor a huge garage that could function as a triage area for mass fatalities, such as train accidents. (This truck bay is large enough to park a semi inside with water and electrical outlets on each pillar, should the entire space need to be converted into an emergency autopsy area.)
The building, which opened in 2010, cost $43.6 million to construct and was the fourth facility to house Baltimore's ever-increasing number of dead. Goldfarb, who has researched the fascinating history of Maryland's medical examiners for a chapter in a forthcoming book, notes that City Council calls for "a dead house, in which to deposit dead bodies" date back to 1861, though it took until 1890 for the first morgue to actually be constructed. (The first coroner dates back to the 1600s and pulled in a hefty salary of 250 pounds of tobacco per case in 1671.) Able to accommodate only eight bodies at a time and located in a smelly, smoky, filthy section of the bustling harbor, it was outdated and inadequate within five years, according to the city's mayor in 1895 who visited on a Friday night and found 18 bodies "placed wherever room could be found." Still, Goldfarb writes, it took until 1925 for a new morgue to be built at 700 Fleet St. In 1969, the "Baltimore Morgue" was given a new building on South Penn Street and a new name, the Medical Examiners Building.
Today, Maryland's Baltimore-based Forensic Medical Center is nationally renowned, attracting police officers, doctors, and forensic investigators from around the country for research and training. The National Association of Medical Examiners described it in its August 2014 accreditation report as "a stellar example of modern and professional medicolegal death investigation." Some of its claims to fame, if such a term can be used in this odd context, are participating in an investigation of President Kennedy's shooting and a post-mortem examination of one of the postal workers who succumbed to anthrax in 2001.
Determining the cause and manner of death requires real efficiency in Maryland. In a state with a population of 5.9 million, roughly 40,000 people die each year; nearly 10,000 of those deaths were investigated by the state medical examiner in 2015, according to Goldfarb.
In Maryland, which has a statewide system headquartered in Baltimore, doctors, police, funeral homes, or families from around the state who are suspicious about a death can refer cases to the medical examiner. A forensic investigator goes to the scene to document it and collect evidence and medical history and brings the deceased to the Baltimore building. If necessary, the cadaver is autopsied. On average, the medical examiner's office conducts 12 autopsies a day, 4,700 annually. Each autopsy takes two-and-a-half to three hours and begins with a physical examination of the body and clothing with marks and tattoos photographed.
When this reporter visited on an October day, there were six "decedents," as they're colloquially called, being autopsied. A police officer sat in a viewing area behind a glass window, presumably following the victim of a homicide he was investigating, as often happens, according to Goldfarb. (Readers, if you are curious about the specific process, keep reading; if you find such details disturbing, you may want to skip the next three paragraphs.) After photographing, measuring, and weighing the corpse, a specially trained police officer carefully collects fingerprints from each hand. The doctor makes a Y incision from each shoulder down the torso and removes the organs to weigh them and collect samples. It is not dissimilar from what most of us have seen on "Bones" or "Cold Case Files" or "NCIS" (though no one wears fancy heels or lipstick in this autopsy room), except for the startling cumulative impact of seeing multiple cadavers being processed with such brisk efficiency. When finished, the doctor scrapes the organ bits off a cutting board into a plastic-lined bucket. Then, as if returning giblets to a chicken, he puts the plastic bag of organs back in the body cavity and stitches it closed.
To collect brain samples, doctors slice the skin around the back of the skull and peel it up and over the bone. They cut into the skull and remove the brain, which must be "fixed" in a formalin solution for several weeks to firm up the tissue so that it can be easily sliced for samples to study. This is why, Goldfarb later explains, there is sometimes a wait of several weeks for the final results of an autopsy.
When the autopsy is done, doctors put the skull back together and stretch the skin back over the face and crown of the head, much like snapping on a bathing cap.
The staff then meets every afternoon for a kind of "grand rounds" where they share results and findings, Goldfarb says. They play devil's advocate and check each other's work before issuing a formal finding for cause and manner of death. Ninety-nine percent of the "decedents" are in and out of the building within 24 hours.
Compared to some of the other attendant costs of homicide, such as murder trials, this detailed analysis of last year's 10,000 dead is fairly cheap. The annual budget hovers around $10 million, less than the state's Fisheries Service budget. It costs the average taxpayer $1.97 per year (compared to the national average of $3 per taxpayer for forensic centers) and comes down to approximately $1,000 per homicide. Rough total: $344,000 total for autopsies in Baltimore's murders this year.
Burying or cremating the dead
Burying the dead is big business. As far back as Jessica Mitford’s 1963 expose of the funeral industry, “The American Way of Death,” and Monty Python’s famous 1970 sketch where an undertaker offers three options for the John Cleese character’s mother—“burn her, bury her, or dump her” (they decide to eat her in the end)—the industry’s aggressive tactics have been chronicled. It doesn’t appear to have hurt the funeral business much.
With more than 30 funeral homes listed in the Yellow Pages for Baltimore, families have a variety options and costs vary—but not all that much.
The Hamilton-based Leonard J. Ruck Funeral Home on Harford Road is one of the few that publishes its General Price List online, though by law every funeral home is required to hand customers a hard copy of the GPL to take home. At Ruck, the basic services of the funeral director and staff (securing death certificates, getting permits for burials, etc.) are the baseline for their work. Getting the remains to the funeral parlor is $360, embalming runs $895, "cosmetics, dressing and casketing" costs $300, visitation or viewing is $700 for the first day, the funeral itself is $550 ($875 if it is on a Sunday or holiday), a grave-side service is $440, a casket coach is $380, a limousine for family members is $190, remains can be kept there for up to 36 hours for free but after that a refrigeration fee is tacked on. Bought as a funeral package with two-day visitation and burial, families will pay $6,860.
None of this includes a casket—and caskets are big-ticket, hard-sell items. A video on Ruck's website called "Simplifying Your Selection: Consumer Information Guide to Selecting a Casket" features a soft-spoken and empathetic, if world-weary, Vanna White type who escorts prospective buyers through a range of options with a reminder that "the ability to personalize a casket can be important for expressing your loved one's individuality." Up-market options include personalized embroidered symbols on the interior fabric; "life symbols" (a cross, an angel, a wild duck mid-flight, a rocky Mount Rushmore-inspired landscape with "dad" carved into the face of the cliff); or a "Memory Safe™ drawer" where loved ones can tuck mementos (a pipe, silver pilot's wings, a book) into the casket to be buried with the dead. Styles of caskets include wood, which averages $3,115 in Maryland, according to the National Funeral Directors Association (some people prefer this for its "warmth and natural beauty," Vanna says) to metals which cost $2,500 and might appeal to those who "prefer durability." Not only are most of the metals "naturally non-rusting," our narrator tells us, but many are "designed with features to help resist the entrance of air, water, and other grave site substances."
Caskets at funeral homes run the gamut, from infant-size to oversized, from stainless steel military-themed to cardboard cremation caskets, from pink "Mother Caskets" to blue "Father Caskets"—for truly cradle-to-grave gender stereotyping. Ruck doesn't list casket prices on its website, but according to Federal Trade Commission they can run as high as $10,000 (and some super-celebrity coffins, like Michael's Jackson's gold-plated number, come in at a whopping $25,000).
Then there are the "extras," like flowers and mementos. At Baltimore's March Funeral Homes, The Sympathy Store (run by LifeTributes.com) encourages mourners to commemorate the dead with everything from tribute blankets like the Lord's Prayer Blanket ($54.99 ) to "Sympathy Sweet Baskets" like the one mounded with Ghirardelli chocolate ($39.95). Flowers like the "Sweet Tranquility Basket" of roses, daisies, and dahlias in wicker are $59.95, while bigger affairs such as the "Sentiments of Serenity Spray"—white roses, white carnations, white lilies on an elevating metal tripod—set buyers back $129.95.
Bereavement accoutrements also extend to those who have cremated their dead. At James A. Morton, a catalog of tear-shaped urns ranged in cost from $45 to $372.50. At The Sympathy Store, there was an array of "cremation jewelry," including a "Tree of Life Memorial Urn Pendant" for $99.95 and a "Cylinder Ash Holder Key Chain," which allows buyers to forever cradle a loved one's ashes between car and house keys in a miniscule urn. (It comes with a tiny funnel to get the ashes inside and some inspirational verse; as with much in this genre, text leans toward Psalm 23:4's "valley of the shadow of death.")
Few people comparison-shop for funerals. And for good reason. Not only do malingerers get charged that aforementioned refrigeration fee if their window-shopping exceeds 36 hours, they are docked for changing their minds. If a body is delivered to one funeral home and family members decide to switch to another, transferring the body runs $2,885.
Though funerals are clearly an a la carte business with wide-ranging price tags, estimated per-funeral costs exist. The median cost of a funeral with viewing and burial in the South Atlantic region was $7,103 in 2015, according to the National Funeral Directors Association. This doesn't include the cost of a vault, a lined and sealed outer container for the casket. "It protects the casket from the weight of the earth and heavy maintenance equipment that will pass over the grave," says NFDA's Koth in an email. "It also helps resist water and preserves the beauty of the cemetery by preventing the ground from settling." State law doesn't require vaults, but many cemeteries do. That bumps the cost to $8,528.
This doesn't include a burial plot or headstone—and slew of additional expenses that cemeteries tack on. Often there are separate charges for digging the grave site and then for filling it back in once the casket is in place—though it's hard to imagine why people would do one without the other. At Oak Lawn Cemetery, which bills itself as "East Baltimore's Best Kept Secret," a his-and-her two-grave lot can be had for $1,250. Flat granite markers start at $620 while upright monuments start at $1,400 (inscribing it will be an additional $232). Done on the cheap, it is going to cost families $2,440 for plot, burial, and marker. Add this to funeral costs ($8,528) and it is $10,968 to get John Doe buried in a local cemetery, or roughly $3.3 million to bury Baltimore's 344 murdered citizens last year.
Government help with burial costs
Coming up with $10,968 on the heels of a sudden death can be a real hardship for many families. (See “A Son’s Death”, where Trina Peterson had friends and family on the streets and at the mall asking for donations to cover the burial of her son when he was shot.) Impoverished families can reach out to Maryland’s Criminal Injuries Compensation Board (CICB), which is managed by the Department of Public Safety and Correctional Services (DPSCS), for help covering burial costs.
CICB processed approximately $6.9 million in claims in 2014, the latest figures available, and 129 of them were related to homicides in Baltimore City with payments totaling $659,550, according to Gerard Shields, a spokesperson for DPSCS. Not of all of the money went to burials, some was for loss of support, but the numbers were combined, says Shields. Baltimore's claims made up 60 percent of CICB's total homicide claims, he says. CICB will cover up to $5,000 for burial costs and while it used to be a pretty rocky ride for families who have to fill out a five-page application for funds, because claims could take up to six months to be processed (a long, basically impractical wait for burial funds), the CICB now processes most claims within 83 days. It also implemented an expedited funeral-claims process that in 2014 would give up to $2,000 within two or three days and get the remaining $3,000 to a funeral parlor within six weeks. This still leaves families $5,968 shy of the average burial cost, but it helps. Maryland's Department of Human Resources also has a burial assistance program, which pays up to $650 for funeral expenses.
If the murder victim is truly a John Doe and no relatives can be found, as was the case with 729 people in Maryland during fiscal year 2015, the unclaimed body is turned over to the State Anatomy Board where it is used for medical research or education.
The State Anatomy Board's original legal mandate was to handle "those bodies to be buried at public expense" and it now handles voluntary body donors as well. The State Anatomy Board facilities are located, as one might expect, in the bowels of a building on West Baltimore Street. The back entrance includes a ramp into a parking garage where a hearse or van can ease a cadaver out without having to parade the dead before pedestrians. Last year, 1,339 "initially unclaimed" bodies came through (families eventually came forward to claim 610 people), according to Ronald Wade, Director of the State Anatomy Board. The corpse lands there for an array of reasons. "It could be a nursing home calls a third cousin in Idaho who doesn't know what to do with the body or it could be economics of the family or it could be a dysfunctional family fighting like hell and they all walk away from it," Wade says.
Wade, whose basement office is located across from a 14-gurney clinical and surgical practice lab for the cadavers, lives and breathes this stuff—and has been doing so for 41 years. His office reflects this. He has a life-size sarcophagus behind his desk, a mummified forearm on his bookshelf, and, in an amusing nod to his raison d'être, a skull pencil holder on his desk. A thin man in a professorial bow tie, he is passionate about the educational benefits of hands-on training and brings out three actual human hearts (fixed into a kind of plasticized form) for this reporter to hold and feel, tracing the fat buildup of one and explaining the enlarged size of another by diagnosis. Being able to touch and explore organs and systems makes a profound difference for students, he explains.
The Anatomy Board has legal control of the unclaimed corpse after three days but Wade says they are always there for a minimum of 14 days and typically they are there for a year before being placed in an educational or research program. They are disinfected and refrigerated. Some end up on the gurneys right across the hall from Wade's office. In this high-tech lab medical students and mortuary students can practice techniques. Sometimes, Wade says, he'll get a call from a doctor who has gone to a convention and heard about a new procedure; the doctor can come in and practice perfecting his technique on one of the cadavers before trying it on a living patient. (None of the bodies go to commercial entities like pharmaceutical research companies.) The cadavers are sorted into programs based on their state. For example, a badly decomposed body might not be of much use to a training program for EMTs who need to practice emergency medicine, but someone who might have been a tissue donor and had a kidney extracted after death would still be useful to help train EMTs or surgeons or students, says Wade. Even those who died of gunshot wounds might be used. "If they did a full autopsy that negates the use of the body," says Wade, "but if it was a clear gunshot wound to the head, they may not have opened the abdomen and it could be used."
It is true, Wade concedes, that anatomy programs had a bad rep because there used to be a lively traffic in cadavers and plenty of grave-robbing when it came to training med students, but that was in the olden days. Now, there are plenty of people who donate their bodies to science. "I've got 80,000 people walking around Maryland with donor cards in their pockets," Wade says.
When medical science is finished with the body, it is cremated. Each year, Wade holds an annual formal ceremony on the grounds of the Springfield State Hospital in Sykesville on the third Monday in June to bury the ashes; 300 to 400 people typically attend. Referring to the unclaimed bodies, Wade says, "I call them 'donors by circumstances'" and says he's committed to a "decent and dignified end." The cost of cremation is borne by the state—and the benefits for education and research likely outweigh the costs.
Police, courts, incarceration—and attendant costs
Let’s fast-forward here—because the costs keep piling up. When considering how much a murder costs a family, a city, a state, the federal government, and citizens, of course, who foot the bill via taxes, the accounting gets complicated and studies tend to lump various figures together.
Thrown into the mix when considering a murder is a police homicide investigation. The Baltimore Police Department said it has no figures on the average amount spent on a murder investigation or the number of hours police spent per murder but national statistics exist, so we'll use those. Then, there is a trial, with the attendant court costs for prosecutors, public defenders, judges, court clerks, stenographers, bailiffs, expert witnesses, crime labs (go here for a profile of a Baltimore forensic technician), and security. Most of those charged with murder are held pretrial for months in the jail and if they are convicted, there are long-term incarceration costs to factor in. When a convicted felon is released, there are re-entry programs and job-training programs.
Meanwhile, there are some soft numbers to consider. A family that is limping along on the precipice of poverty—or really, any citizen who is living paycheck to paycheck (61 percent of Americans lack a "rainy day" fund for emergencies, according to a 2013 Federal Reserve study)—gets a devastating economic blow on top of the emotional trauma a murder brings. This holds true for the families of victims who may have lost a breadwinner and the families of perpetrators, who may see their breadwinner incarcerated for several decades. Both households are now single-parent families; if they are struggling, they may rely on public assistance, public housing, food stamps, Medicaid, subsidized day care, tuition assistance for college-bound children, etc. As has been well documented in the press, depression, post-traumatic stress, suicide attempts, and other mental illness often follows on the heels of having witnessed a violent death or having lost someone to violence.
A rich stew of potential costs roils these waters.
So it's not surprising that studies calculating the larger costs of homicide are hard to come by and the figures much disputed. Still everyone from scholars to the Department of Justice to the National Institutes of Health have taken a stab at the numbers game.Studies range from $1.2 million for what researchers call "tangible costs" per murder to more than $17 million when the "intangibles" are thrown in. Most studies, such as a 2010 National Institutes of Health Study called "The Cost of Crime to Society" which set the "tangible" cost of one murder at $1.2 million and the "intangible" cost at more than $8.4 million, look at four categories of costs: medical costs for victim (ER, ambulance, etc.), criminal justice (police, courts, jails), life of crime costs, and intangible costs for victims (loosely defined as pain and suffering by surviving family members and/or estimated lost earnings from deceased).
The studies are controversial. According to Mark A. Cohen, a professor at Vanderbilt University who has been studying the economics of crime since his 1985 stint with the U.S. Sentencing Commission, there are ways to calculate the costs of particular crimes but how the data is used by policy-makers can be sketch. In his 2005 book "The Cost of Crime and Justice," Cohen takes a deep dive into the issue and maps out the impact of such numbers, explaining in the introduction that they are controversial—for both conservatives and progressives. Conservatives use his research as a lock-'em-up-and-throw-away-the-key argument (see how much homicides cost society?) while progressives use it as ammunition for crime-prevention programs, insisting that even seemingly expensive violence-deterrence or rehabilitation programs save society tons of money (it's a bargain because murder is so darn expensive). Policy-makers play fast and loose with the data. "In cost-benefit analysis, you have to look at the alternatives, too," Cohen says in a phone interview. "Is there a better alternative that is less costly [than the status quo]?"
Researchers also began adjusting their "pain and suffering" calculations around this time based on a formula using jury awards for "pain and suffering" and that brought numbers up. They began to include crime-prevention programs and what people were willing to pay for such things.
Some analysts assess more offbeat intangibles linked to crime rates. A 2012 report by the Center for American Progress found that if a city could reduce the murder rate by 25 percent, housing prices would jump by 2.1 percent. Further, money saved in handling the slew of homicides could be used to bolster other public programs and boost quality of life, CAP pointed out; that in turn would bring in additional revenue by attracting new businesses and new, tax-generated income.
Still, difficult as it is to tease out the minutiae of various calculations, real numbers exist. Cohen, who is pretty much the guru of this kind of number crunching, shared his 2009 "Journal of Quantitative Criminology" paper on the topic, by way of directing this reporter toward some all-encompassing, scientifically-arrived-at numbers. Turns out, according to Cohen, murder comes with a huge price tag—an estimated $11.8 million. This is a conservative estimate in 2007 dollars. Rough estimate: Baltimore's 344 homicides last year cost north of $4 billion.